In these patients pain treatment modalities quality elavil 25mg, depression usually plays a rфle and the clinician must not underestimate the value of tricyclic antidepressants myofascial pain treatment center virginia generic elavil 50mg online. Anticonvulsants gabapentin and carbamazepine appear to benefit many patients pain treatment in osteoporosis purchase elavil 10mg with visa, probably due to their membrane stabilizing effect alternative pain treatment center tacoma generic elavil 75mg line. Topical treatment capsaicin blocks substance P and inhibits pain transmission in the skin. In chronic pain from terminal malignancy, patients often require strong narcotics morphine, heroin. Narcotic infusion appears useful for controlling postoperative pain and intractable pain in patients with terminal malignancy. Although endorphin release occurs, the rфle of the placebo effect remains unclear. Alternatively a percutaneous radiofrequency heat lesion applied to the posterior ramus of the spinal nerves exiting from the intervertebral foramen, denervates the facet joints. This technique relieves facet joint pains in the majority of patients, but as the nerve regenerates, pain returns unless preventative measures are adopted. The mechanism of relief remains uncertain; this is not merely due to tumour regression. It is usually applicable in malignant states where simple methods of pain control have failed. Conditions with loss of pain perception exemplify this, resulting in frequent injuries, burns and subsequent mutilations. Pathological conditions do, however, cause pain as a symptom of cancer, injury or other disease. Touching the limb aggravates the pain, and the patient resents any interference or attempt at limb mobilisation. A vascular accident which involves the inhibitory portion of the thalamus may result in pain the thalamic syndrome. Clinical features: Hemianaesthesia at onset contralateral to the lesion precedes the development of pain. This is burning and diffuse, Caudate nucleus and exacerbated by the touch of clothing. Paradoxically the thalamic syndrome may occur Globus following a thalamic stereotactic procedure for pallidus Putamen movement disorders. Referred pain of a dull quality relates to a specific area of the body surface often hypersensitive to touch. The basis of referred pain the visceral afferents converge upon the same cells in the posterior horns as the somatic efferents. A knowledge of the source of referred pain is important in diagnosis and treatment. An intolerable tingling, burning sensation or pain in both legs, occurring only when sitting or lying down and relieved by walking; no associated neurological abnormality. Often responds to dopamine agonists (ropinerole and pramipexole), L-dopa and gabapentin. There are many causes and clinical evaluation and appropriate investigation is often difficult. Inflammatory pain results from disruption of muscle fibres, inflammatory exudate and fibre swelling. Ischaemic pain results from metabolic change, usually in response to exercise and is deep and aching. Muscle pain may be physiological as a consequence of extreme exercise or pathological as a consequence of muscle, soft tissue or systemic illness. Fibromyalgia A common condition of uncertain pathology in which generalised muscle pain with localised tender areas occurs without objective clinical or laboratory abnormalities. Malignant hyperpyrexia Characterised by a sudden rise in body temperature whilst undergoing general anaesthesia, usually with halothane or succinylcholine. Muscle abscess Commonly Staphylococcal due to local trauma or blood-borne in debilitated persons. Polymyalgia rheumatica Proximal muscle pain encountered in the elderly and often associated with giant cell arteritis. No clear underlying pathology has been found and diagnosis is based on symptoms and exclusion of other pathology. May respond to graded exercise, tricyclic antidepressants or cognitive behavioural therapy. In a welfare state, society may carry most, if not all of the financial burden, particularly with more severe disability. Conditions causing brain damage do not respect age; survivors may need long-term care. Such classifications provide end-points for audit and research, and a means of assessing therapeutic intervention. They permit prediction based on clinical and investigative findings early in the course of the disease. The Vegetative State Severe bilateral hemisphere damage may result in a state in which the patient has no awareness of themselves or of their environment. Although periods of eye opening and closure may occur suggesting sleep/wake cycles, along with spontaneous movements of the face, trunk and limbs, the patient does not communicate or interact with others in any way. At one month after trauma, about 1/3 of patients in the vegetative state will show some improvement over the subsequent year. After non-traumatic coma, outcome is much worse; only about 7% show some improvement and have severe disability. A government working party has published guidelines for the diagnosis of brain death which, when fulfilled, indicate that recovery is impossible. In these patients, organs may be removed for transplantation before discontinuing ventilation. The tests are designed to detect failure of brain stem function, but certain preconditions must first be met. Hypothermia must not be a primary cause ensure that temperature is not less than 35°C. The patient must be on a ventilator as a result of inadequate spontaneous respiration or respiratory arrest if a neuromuscular blocking drug has been used, exclude a prolonged effect by observing a muscle twitch on nerve stimulation. Movements can occur in response to limb or trunk stimulation (especially in the legs), and tendon reflexes may persist in a patient with brain stem death but intact cord function. Conversely, limb movements and reflexes may be absent in a patient with an intact brain stem and spinal cord damage. During this test, anoxia is prevented by passing 6 litres O2 per minute down the endotracheal tube. Test repetition and timing the test should be repeated but the interval should be left to the discretion of the clinician. The initial test may be performed within a few hours of the causal event, but in most instances is delayed for 1224 hours, or longer if there is any doubt about the preconditions. Old concepts of death occurring at the time the heart ceases to beat are no longer applicable. Similarly, angiography or cerebral blood flow measurement are of no additional value to the clinical tests described above, provided the preconditions are fulfilled. Approximately 300 per 100000 of the population per year require hospital admission; of these 9 per 100000 die, i. The principal causes of head injury include road traffic accidents, falls, assaults and injuries occurring at work, in the home and during sports. The relative frequency of each cause varies between different age groups and from place to place throughout the country. Head injuries from road traffic accidents are most common in young males; alcohol is frequently involved. Road traffic accidents, although only constituting about 25% of all patients with head injury, are the cause of more serious injuries. This cause contributes to 60% of the deaths from head injury; of these, half die before reaching hospital. In many countries preventative and punitive measures controlling alcohol levels and the use of seat belts, air bags and crash helmets have reduced the incidence.
Benign pain and spine treatment center dworkin safe elavil 50mg, but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential pacific pain treatment center santa barbara generic 10 mg elavil with mastercard. Tumor composed of large cells with clear cytoplasm and central nuclei (resemble oocytes myofascial pain syndrome treatment guidelines buy cheap elavil 10 mg on-line. Testicular counterpart is called seminoma shingles and treatment for pain purchase elavil 75mg without a prescription, which is a relatively common germ cell tumor in males. Malignant tumor that mimics the yolk sac; most common germ cell tumor in children 2. Schiller-Duval bodies (glomerulus-like structures) are classically seen on histology. Malignant tumor composed oftrophoblasts and syncytiotrophoblasts; mimics placental tissue, but villi are absent 2. Postmenopause (most common setting for granulosa-theca cell tumors)endometrial hyperplasia with postmenopausal uterine bleeding 3. Composed of Sertoli cells that form tubules and Leydig cells (between tubules) with characteristic Reinke crystals 2. Associated with pleural effusions and ascites (Meigs syndrome); syndrome resolves with removal of tumor. Krukenberg tumor is a metastatic mucinous tumor that involves both ovaries; most commonly due to metastatic gastric carcinoma (diffuse type) 1. Bilaterality helps distinguish metastases from primary mucinous carcinoma of the ovary, which is usually unilateral. Implantation of fertilized ovum at a site other than the uterine wall; most common site is the lumen of the fallopian tube. Classic presentation is lower quadrant abdominal pain a few weeks after a missed period. Surgical emergency; major complications are bleeding into fallopian tube (hematosalpinx) and rupture. Miscarriage of fetus occurring before 20 weeks gestation (usually during first trimester) 1. Most often due to chromosomal anomalies (especially trisomy 16}; other causes include hypercoagulable states. Effect of teratogens generally depends on the dose, agent, and time of exposure (Table 12. Implantation of the placenta in the lower uterine segment; placenta overlies cervical os (opening). Improper implantation of placenta into the myometrium with little or no intervening decidua B. Presents with difficult delivery of the placenta and postpartum bleeding Table 12. Pregnancy-induced hypertension, proteinuria, and edema, usually arising in the third trimester; seen in approximately 5% of pregnancies 1. Due to abnormality of the maternal-fetal vascular interface in the placenta; resolves with delivery C. Risk factors include sleeping on stomach, exposure to cigarette smoke, and prematurity. Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts Table 12. Focal proliferation present around hydropic villi Minimal Empty ovum fertilized by two sperm (or one sperm that duplicates chromosomes); 46 chromosomes Absent Most villi are hydropic. Diffuse, circumferential proliferation around hydropic villi 2-3% Fetal tissue Villous edema Trophoblastic proliferation Risk for choriocarcinoma. Uterus expands as if a normal pregnancy is present, but the uterus is much larger and much higher than expected for date of gestation. Classically presents in the second trimester as passage of grape-like masses through the vaginal canal. With prenatal care, moles are diagnosed by routine ultrasound in the early first trimester. Subsequent monitoring is important to ensure adequate mole removal and to screen for the development of choriocarcinoma. Choriocarcinoma may arise as a complication of gestation (spontaneous abortion, normal pregnancy, or hydatidiform mole) or as a spontaneous germ cell tumor. Choriocarcinomas that arise from the gestational pathway respond well to chemotherapy; those that arise from the germ cell pathway do not. Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes B. Sexually transmitted disease caused by Chlamydia trachoma this (serotypes Ll-L3) C. Eventually heals with fibrosis; perianal involvement may result in rectal stricture. Lack of circumcision- Foreskin acts as a nidus for inflammation and irritation if not properly maintained. Bowen disease-in situ carcinoma of the penile shaft or scrotum that presents as leukoplakia 2. Erythroplasia ofQueyrat- in situ carcinoma on the glans that presents as erythroplakia 3. Bowenoid papulosis- in situ carcinoma that presents as multiple reddish papules i. Seen in younger patients (40s) relative to Bowen disease and erythroplasia of Queyrat ii. Testicles normally develop in the abdomen and then "descend" into the scrotal sac as the fetus grows. Most common congenital male reproductive abnormality; seen in 1% of male infants C. Most cases resolve spontaneously; otherwise, orchiopexy is performed before 2 years of age. Complications include testicular atrophy with infertility and increased risk for seminoma. Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae-Seen in young adults. Increased risk of sterility, but libido is not affected because Leydig cells are spared. Escherichia coli and Pseudomonas-Seen in older adults; urinary tract infection pathogens spread into the reproductive tract. Mumps virus (teenage males)-increased risk for infertility; testicular inflammation is usually not seen in children< 10 years old. Twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction. Usually due to congenital failure of testes to attach to the inner lining of the scrotum (via the processus vaginal is) C. Tunica vagina lis is a serous membrane that covers the testicle as well as the internal surface of the scrotum. Associated with incomplete closure of the processus vaginal is leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults). Usually not biopsied due to risk of seeding the scrotum; removed via radical orchiectomy l. Seminomas (55% of cases) are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis. Nonseminomas (45% of cases) show variable response to treatment and often metastasize early. Seminoma is a malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resemble spermatogonia. Embryonal carcinoma is a malignant tumor comprised of immature, primitive cells that may produce glands. Chemotherapy may result in differentiation into another type of germ cell tumor. Yolk sac (endodermal sinus) tumor is a malignant tumor that resembles yolk sac elements. Choriocarcinoma is a malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta-like tissue, but villi are absent. Teratoma is a tumor composed of mature fetal tissue derived from two or three embryonic layers.
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Some time back fetal cell transplant was tried pain solutions treatment center marietta ga generic elavil 25mg, however rush pain treatment center meridian ms order elavil 25 mg fast delivery, due to certain ethical issues and medicolegal problems pain treatment satisfaction questionnaire discount 75 mg elavil mastercard, this did not gain momentum treatment for acute shingles pain generic 75mg elavil mastercard. Besides, the medical and surgical treatment various factors like regular exercise, staying happy, meeting groups, yoga etc. Early diagnosis, appropriate treatment under the guidance of an expert physician or a neurophysician, group therapy, exercise, yoga and if necessary surgery can control this disease to a large extent. In the cities like Ahmedabad and Mumbai, there are associations of patients suffering from Parkinsonism, which give relevant information regarding the disease, teach exercises and yoga in groups and provide other services to the patients. Amongst the other causes of dementia are diseases of thyroid, parathyroid, diabetes, effect of toxic chemicals, and heavy metals etc. The orientation of time and places gets affected Depression, loss of interest in life, excessive anger. As the disease progresses the patient finds difficulty in carrying out routine day-to-day activities. The patient starts forgetting his day-to-day incidents and the names of his near and dear ones. The patient makes mistakes in recognizing his relatives, friends and familiar things, and starts keeping things in wrong places. There is difficulty in talking or communicating and also in moving around, patient loses road sense. Due to change in temperament, he/she gradually loses touch with near and dear ones. The reason of this destruction is not decreased blood circulation, infection or aging. It is a well known fact that many famous people like former American President Ronald Reagan, Rita Heyworth, Sugar Ray Robinson, E B White and others have suffered from this disease. However, extensive research is being carried out to design drugs to decrease the intensity of the symptoms. If the disease is diagnosed in the initial phase, it can help the patient to a great extent. The patient and his relatives should have proper information and education regarding the disease in order to cope with day-to-day problems and difficulties. Mini mental status examination, word list memory test, work recall test and various neuropsychological measures are used to diagnose the disease and its intensity. Amongst newer medicines there are Rivastigmin (Exelon) and Galantamine (Reminyl) with even better results. Other treatments like genetic engineering and cloning are still in experimental stage. In our country, cost is a problem and therefore Piracetam (Normabrain; Nootropil) or Ergot group of medicines are more popular to these costly newer drugs. Multi-infarct Dementia: When a decrease in the supply of blood to various small portions of the brain damages the ce;;s in those areas then Multi-infarct Dementia results. A rise in the blood pressure damages small capillaries and small clots are formed in these capillaries, which results in lowering of the blood supply in certain parts of the brain. Initially, memory loss (especially the memories of the recent events) takes place. But as the disease progresses, the condition of the patient deteriorates substantially. This can also be accompanied by paralysis, depending upon the location of the infarcts. The lipid profile, Doppler of the blood vessels of the neck, 2D Echo of the heart etc are the tests which are specially helpful in the detection of the disease. Along with the drugs for thinning of the blood, regulating blood pressure and diabetes strictly, maintaining discipline in eating habits and regular exercise are very essential to prevent this disease. In some countries such facilities are available where genetic investigations can accurately predict the possibility of a person suffering from this disease in future. Sometimes, symptoms similar to dementia can also be seen in severe mental stress or depression. Prevention of Dementia and Improving Brain Power: It is believed that as the age progresses the cells in the brain degenerate, gradually resulting in loss of memory as well as mind power. Recent research has shown that if the right kind of environment is provided there can be development of the new nerve fibres in the brain of older or aging people. The day should start with some jogging, which speeds up the circulation of the blood in the body. This will result in more supply of blood and oxygen to the brain, which will keep the nervous system alert. One should develop a taste for food rich in carbohydrates (glucose based) rather than fatty foods. After every one to one and half-hours of work, it is advisable to take a break for some minutes and move around for some time. Diverting the mind to a different subject after continuous working on a particular subject can make the brain more alert. Fatty foods should be restricted and protein content in the food should be in moderation. After meals one feels drowsy because the blood supply to the brain decreases, so only limited food should be eaten in the afternoon. Therefore, one must make a habit of playing games like memory games, or crosswords (neurobics etc). Try to use memory as far as possible, for example, avoid making a list while going for shopping. Try remembering telephone numbers or birthdays of friends and relatives or at least try to remember the birthdays of close relatives and family members. One should end the day with positive thoughts without any worries, which is not a very difficult task. Sufficient sleep is very important for development of memory and working of the brain. Few tips for students to improve memory: l While you settle down to study, keep your textbooks, notebooks, pen etc. If you find the subject difficult, resort to deep-breathing for 2 minutes so as to increase your concentration. Note down the important points Discuss what you have read with your friends and then open the book and confirm what you have retained. Similarly to read the next one and after reading for a while, to keep the book aside and try to remember everything. To write all important points, or discuss with the colleagues and then review if any points are left out. To repeat very briefly the same topic after 24 hours, 7 days and 30 days; help a lot to remember the topic permanently. One can use pnemonics or graphics or melodies to remember certain unusual things or long lists or more points. To rejuvenate oneself, one may get up and walk around or breathe deeply or meditate for a while. As mentioned early, there is no definite, effective or quick way to improve memory; however the method given above is time tested method to improve memory performance for students as well as other people. If there is an infection in the nose and the ears with pus discharge, throat infection, infectious boils on the face, pus in the other body parts like the chest or septicemia, then there is a possibility of infection in the brain. If there is a head injury with bleeding from the nose or ears or a skull fracture with C. This can lead to headache, fever, seizures, paralysis, unconsciousness or even death. It is not possible to describe all these diseases here, but some important diseases will be discussed. Tuberculosis of the Brain: Usually, tuberculosis infection of the brain comes from other parts of the body like lungs or stomach. Headache, low-grade fever, vomiting, loss of appetite, excessive weakness or anxiety are the initial symptoms of this disease. Gradually, seizures, paralysis of one or more limbs can occur and in advanced stage, coma due to the edema of the brain and even death may occur. F are obstructed, the result is hydrocephalus, in which the cerebral ventricles dilate leading to unconsciousness or loss of eyesight.
In the management of acute low back pain pain treatment ovarian cyst generic 25 mg elavil mastercard, several factors may suggest a possible early presentation of a serious condition pain management utica buy discount elavil 50mg on-line. Urgent evaluation should be considered for any patient who is in severe pain treatment center utah purchase elavil 10mg amex, writhing pain pain treatment center winnipeg discount elavil 50mg line, as this may be the early presentation of an intra-abdominal vascular process, such as a dissecting abdominal aortic aneurysm. Patients who have significant pain at rest may be harboring an infectous or neoplastic process involving the spine or spinal column. Finally, any patient with an evolving neurological deficit such as sacral anesthesia, bowel or bladder incontinence, or progressive sensory motor dysfunction, should be referred to an appropriate center for urgent evaluation. Recent studies have shown that two days of bedrest are as effective as seven days of bedrest and result in 45 percent less time lost from work. Generally in a military environment, where a patient is either fit or not fit, it is often not feasible to return a patient to partial work status, so that prolonged bedrest may be indicated in certain occupational rates. During the bedrest phase, a variety of medications can be considered, such as analgesics, muscle relaxants, or nonsteroidal anti-inflammatory medication. Drugs with a high narcotic potential, such as Percocet or Percodan, should be avoided and Valium should not be used as a muscle relaxant as it also has a serious side effect of depression. Upon resolution of the severe back pain, once the patient is ambulatory, a variety of physical therapy programs should be considered, including strengthening exercises, range of motion, ultrasound, heat and cold packs, and transcutaneous nerve stimulation. In general, gravity traction or bedrest traction is ineffective and can lead to serious secondary complications and should be avoided. Perhaps the most important aspect following improvement of the acute phase, is the back education program, the so-called "low-back school", available in some physical therapy departments. An evaluation by an experienced physician in the workplace may lead to improvements in occupational procedures to reduce recurrence of low back pain. In general, manipulation with rapid changes of direction may actually further weaken spinal ligaments. Conservative therapy of acute low back pain with sciatica is usually effective, as 50 percent of patients with sciatica will usually resolve their symptoms within six weeks. Those who fail to respond to conservative therapy should be referred for surgical intervention. Patients whose symptoms continue for more than six weeks should undergo further medical evaluation including a complete blood count and sedimentation rate, and consideration for radionuclide bone scan and lumbosacral spine X-rays. Sciatica, or lumbar radiculopathy is manifested by pain, weakness, or sensory loss in a nerve root distribution in the lower extremity. Although, it is commonly due to a herniation of the nucleus pulposus with impingement of the nerve root, it may also be caused by compression of the cauda equina from tumor, abscess, or hemorrhage, or impingement of the nerve root by hypertrophy of the lumbar facets, causing spinal stenosis. Other less common causes include congenital anomalies of the nerve roots, nerve and bone tumors, metastatic disease, and degenerative synovial cysts (Tarlov cysts). Sciatic leg pain may also be caused by extraspinal involvement of the lumbosacral plexus, by tumors or endometriosis involving the pelvic peritoneum, or by compression of the sciatic nerve near the hip due to external compression from a wallet or prolonged sitting, or by localized tumors of the sciatic nerve. Despite this rather extensive differential of sciatica, the majority of cases are related to a degenerative condition of the lumbar disk. The most likely levels involved are the L4-L5 disk causing an L-5 radiculopathy, or the L5-S1 disk causing an S-1 radiculopathy. The L-5 radiculopathy causes weakness of the dorsiflexors and evertors of the foot and numbness and pain over the lateral aspect of the leg and ankle and dorsal aspect of the foot. The S-1 radiculopathy results in weakness of the ankle plantar flexors and hamstrings and numbness and pain over the lateral aspect of the sole of the foot. Another clinical entity is lumbar neurogenic claudication, usually due to lumbar spinal stenosis. Narrowing of the central canal and lateral aspect of the spinal column results in low 7-58 Neurology back pain and bilateral leg pain primarily while ambulating. Lumbar neurogenic claudication, seen with degenerative spine disease, is characterized by the lack of signs of vascular insufficiency (atrophic skin and diminished distal pulses). Neurogenic pain usually resolves after resting for 15 or 30 minutes, whereas pain due to vascular insufficiency, which is usually confined to the calves, resolves immediately with rest. Persons with lumbar spinal stenosis walk in the flexed position because in the extended position, the central canal is compressed, resulting in prominent pain and weakness. Examination of the lumbar spine should include physical examination of the spinous processes and alignment, looking for excessive lordosis, scoliosis, and vascular skin lesions (birthmarks). Evaluation: of the spine should include range of motion (extension, flexion, lateral flexion, and lateral rotation). Extreme range of motion can be ascertained by having the patient bend and touch his toes. Examination of the muscle groups of the lower extremity should include individual muscle group testing of the hip flexors, extensors, abductors, and adductors; knee flexors and extensors; ankle dorsiflexors, plantar flexors, invertors and evertors; and toe dorsiflexors and plantar flexors. Muscle strength may also be tested by having the patient heel walk, toe walk, hop on one foot, duck walk, and do one-legged deep knee bends. The leg is slowly elevated and if pain is reproduced in the back of leg, the angle the leg is raised to produce pain should be noted. The femoral stretch maneuver starts with the patient in the prone position and the leg extended at the knee. This stretches the lumbar L-4 nerve root and reproduction of symptoms may be indicative of lumbar disk disease at the L3-L4 level. Sensory examination of the lower extremities should include light touch and pinprick. If bowel or bladder symptoms are present, test sensation around the anus and perineal region. Reflex examination should include the quadriceps (knee jerk) and gastrocnemius (ankle jerk) reflex. The cremasteric and bulbocavernous reflex should be tested if the patient has bowel or 7-59 U. Patients who fail to respond to conservative therapy and have signs of radicular symptoms over six weeks should be referred for neurological or orthopedic evaluation. Patients with low back pain whose symptoms are unremitting or severe, or have profound weakness should be evaluated on an urgent basis, particularly if there are indications of a neoplastic or infectious process. Neck Pain and Upper Extremity Radioculopathy A variety of conditions may cause pain in the neck or upper extremities. Perhaps the most common is cervical spondylosis or disc disease of the cervical region. The most common disc syndrome in the cervical region is a C-6 radiculopathy, which causes weakness of the proximal upper extremity (deltoid, biceps, and wrist flexors), diminished biceps and brachioradialis reflex, numbness over the thumb and index finger, and pain in the arm radiating to the thumb and index finger. The next most common disc syndrome is a C-7 radiculopathy, which causes weakness of the triceps and wrist extensors, numbness of the middle finger and diminished triceps reflex. C-8 radiculopathy causes pain in the arm radiating to the ring and little finger and weakness of the hand intrinsic muscles, primarily finger flexors. Cervical disc disease is managed similar to lumbar disc disease, with bedrest and analgesics as necessary, and physical therapy after the acute phase. Peripheral Neuropathies Peripheral neuropathies are due to a variety of etiologies, but in the young active-duty military population, they are most commonly due to trauma or chronic entrapment syndromes. In the older age groups, diabetes and alcohol are possibilities, as well as inflammatory peripheral neuropathies. Toxic neuropathies can occur from exposure to a variety of solvents and chemicals used in aviation maintenance and ordinance. Hereditary neuropathies are quite common, and may be cumulative with the effects of other neuropathies. Peripheral nerves may be injured by a variety of physical means, including percussion, traction, compression, ischemia, cold, or by transection. An injury classification of peripheral nerve injuries is based on anatomic damage. The most common injury type of peripheral nerves is neuropraxia, which is a localized (segmental) demyelination. The next injury type is axonotomesis, which is damage to the axon cylinders of the nerve. Damage of this type requires 7-60 Neurology a longer period for recovery and this type of nerve injury may take months to recover. The last, and worst type of injury is neurontomesis, which is a disruption of both the axon cylinder and myelin.
